title: [Nebulized colistin treatment of multi-resistant Acinetobacter baumannii pulmonary infection in critical ill patients].
abstract: OBJECTIVE
  To analyze the efficacy of nebulized colistin in the microbiological eradication and clinical improvement of patients with pulmonary infection by multi-resistant Acinetobacter baumannii (MAB).
  
  
  METHODS
  A retrospective study.
  
  
  METHODS
  Intensive Care Unit of a Tertiary hospital.
  
  
  METHODS
  Hospitalized patients on invasive mechanical ventilation with positive MAB cultures of the airway.
  
  
  METHODS
  All received treatment with colistin (CL). Nosocomial pneumonia (NP) or Tracheobronchitis (TB) was determined according to routine criteria and colonization (CO) was determined in the case of a positive culture in the absence of infection criteria. Three groups of patients were defined: those treated with nebulized CL, those treated with IV CL and those treated with IV CL plus nebulized CL.
  
  
  METHODS
  Baseline characteristics. Microbiological eradication and clinical recovery were evaluated according to routine criteria.
  
  
  RESULTS
  83 patients were studied, 54 of whom were treated, with the following diagnoses: 15 (27.8%) with NP, 16 (29.6%) with TB and 23 patients (42.6%) with CO. Nebulized CL was used in 36 patients (66.7%): 66.7% of which for CO, 33.3% in treatment for TB and in no case of NP. In 61.1% of the patients, IV CL was used: 22.2% of which for CO, 38.9% for TB and 38.9% in NP. The combination of IV CL and nebulized CL was used in 15 patients (27.8%): 5 patients (33.3%) CO, 2 patients (13.3%) TB and 8 patients (53.3%) NP. Microbiological eradication was achieved in 32 patients (59.3%), with the following distribution: 8 (47.1%) with IV CL, 15 (83.3%) with nebulized CL and 9 patients (69.2%) with a combination of IV CL and nebulized CL. Clinical recovery was achieved in 42 patients (77.8%): 12 (80%) with IV CL, 18 (94.7%) with nebulized CL and 12 (85.7%) with a combination of nebulized and IV CL. These differences were not significant. In the group of patients with infection due to TB and NP (31 patients, 57.4%), microbiological eradication was achieved in 5 patients (100%) treated with nebulized CL and in 6 of the 9 patients (42.9%) treated with IV CL, the difference being significant (P<.05). Clinical recovery in this group was 100% (6 patients) treated with nebulized CL and 75% (9 of the 12 patients) in the IV CL group. This difference was not significant.
  
  
  CONCLUSIONS
  Our study suggests that treatment with colistin in patients with pulmonary infection with multi-resistant Acinetobacter baumannii could be more efficient if it were to be administrated solely nebulized or in combination with IV colistin rather than administered solely intravenously.
authors.affiliation: Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pérez-Pedrero
authors.forename: M
authors.initials: M
authors.lastname: Sánchez-Casado
authors.forename: S
authors.initials: S
authors.lastname: Rodríguez-Villar
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001991:Bronchitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004305:Dose-Response Relationship, Drug; D004341:Drug Evaluation; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D014136:Tracheitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014140:Tracheotomy
chemical_list: D003091:Colistin